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Dai J, Li, J, He, X, Huang, H, Li Y. A relationship among the blood serum levels of interleukin-6, albumin, and 25-hydroxyvitamin D and frailty in elderly patients with chronic coronary syndrome. Aging Med (Milton) 2022; 5:17-29. [PMID: 35309153 PMCID: PMC8917258 DOI: 10.1002/agm2.12201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 01/09/2023] Open
Abstract
Background With the aggravation of the aging of the world population, frailty has become one of the common complications in elderly people. Its diagnosis is not objective, the pathogenesis is not clear, and interventions are not sound, thus intensifying the problem. Furthermore, frailty is closely associated with the occurrence and poor prognosis of coronary atherosclerotic heart disease. Moreover, few studies report on the prevalence of frailty in elderly patients with the chronic coronary syndrome (CCS). Objective We aimed to investigate the prevalence of frailty in elderly patients with CCS. We analyzed the correlation between the blood serum levels of interleukin‐6 (IL‐6), albumin (Alb), and 25‐hydroxyvitamin D (25(OH)D) with frailty in elderly patients with CCS. We have also provided recommendations for helping the objective diagnosis as well as proposed new intervention methods in the future. Methods Two hundred eight‐eight inpatients (≥60 years) with the chronic coronary syndrome were recruited at the Department of Geriatrics, the First People's Hospital of Yunnan Province, China. General information and laboratory examination data were collected. The comprehensive geriatric assessment was conducted via an internet‐based platform of the Comprehensive Geriatric Assessment (inpatient version) developed by us, among which frailty was assessed by the Chinese version of Fried Frailty Phenotype, a component of the assessment scale. Results Among the total number of old patients with CCS, 87 (30.2%) had no frailty, 93 (32.3%) had early frailty, and 108 (37.5%) had frailty. According to the multivariate logistic regression analysis, after adjusting for confounding factors, IL‐6 (OR = 1.066, 95% CI 1.012–1.127), Alb (OR = 0.740, 95% CI 0.560–0.978), and 25(OH)D (OR = 0.798, 95% CI 0.670–0.949) were independently associated with frailty in the three groups of models. Conclusion IL‐6 proved to be a risk factor for frailty in elderly patients with CCS, while Alb and 25(OH)D were protective factors, which make the potential targets for predicting and intervening frailty in elderly patients with CCS.
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Affiliation(s)
- Jing‐rong Dai
- School of MedicineKunming University of Science and TechnologyKunmingChina
- Department of GeriatricsThe First People's Hospital of Yunnan ProvinceKunmingChina
| | - Jie Li,
- School of MedicineKunming University of Science and TechnologyKunmingChina
- Department of GeriatricsThe First People's Hospital of Yunnan ProvinceKunmingChina
| | - Xu He,
- School of MedicineKunming University of Science and TechnologyKunmingChina
- Department of GeriatricsThe First People's Hospital of Yunnan ProvinceKunmingChina
| | - Hong Huang,
- School of MedicineKunming University of Science and TechnologyKunmingChina
- Department of GeriatricsThe First People's Hospital of Yunnan ProvinceKunmingChina
| | - Yan Li
- School of MedicineKunming University of Science and TechnologyKunmingChina
- Department of GeriatricsThe First People's Hospital of Yunnan ProvinceKunmingChina
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González DA, Gonzales MM, Resch ZJ, Sullivan AC, Soble JR. Comprehensive Evaluation of the Functional Activities Questionnaire (FAQ) and Its Reliability and Validity. Assessment 2021; 29:748-763. [PMID: 33543638 PMCID: PMC8339133 DOI: 10.1177/1073191121991215] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The Functional Activities Questionnaire (FAQ) is a collateral-report measure of difficulties in activities of daily living. Despite its widespread use, psychometric analyses have been limited in scope, piecemeal across samples, and limited primarily to classical test theory. This article consolidated and expanded psychometric analyses using tools from generalizability and item response theories among 27,916 individuals from the National Alzheimer's Coordinating Center database who completed the FAQ. Reliability was evaluated with internal consistency, test-retest, and generalizability analyses. Validity was assessed via convergence with neurocognitive measures, classification accuracy with impairment stage, and confirmatory factor and item response theory analyses. Demographics did not impact scores and there was strong evidence for reliability (0.52-0.95), though coefficients were attenuated when restricted in range to diagnostic groups (e.g., normal cognition). There were strong correlations with neurocognitive measures (rs: -.30 to -.59), strong classification accuracy (areas under the curve: .81-.99), and a single-factor model had excellent fit. All items evidenced strong item response theory discrimination and provided significant information regarding functional disability, albeit within a relatively restricted range. The FAQ is a reliable and valid measure of activities of daily living concerns for use in clinical/research settings. It best assesses mild levels of functional difficulty, which is helpful in distinguishing normal cognition from mild cognitive impairment and dementia.
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Affiliation(s)
| | - Mitzi M Gonzales
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Zachary J Resch
- University of Illinois College of Medicine, Chicago, IL, USA
| | - A Campbell Sullivan
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Jason R Soble
- University of Illinois College of Medicine, Chicago, IL, USA
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3
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Røe C, Anke A, Arango-Lasprilla JC, Andelic N, Caracuel A, Rivera D, Norup A. The Family Needs Questionnaire-Revised: a Rasch analysis of measurement properties in the chronic phase after traumatic brain injury. Brain Inj 2020; 34:1375-1383. [PMID: 32758024 DOI: 10.1080/02699052.2020.1802664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The main aim was to evaluate the measurement properties of the Family Needs Questionnaire-Revised (FNQ-R) in family members of individuals living with severe traumatic brain injury (TBI). METHODS A total of 309 family members of individuals with severe TBI from Colombia, Denmark, Mexico, Norway and Spain participated. Rasch analysis of the FNQ-R and its 6 subscales was conducted. RESULTS The Rasch analysis indicated a lack of fit of the 37-item FNQ-R to one single underlying construct of needs, and less than half of the items were invariant across the countries. Misfit of single items was revealed in the Need for Health Information, Need for Emotional Support, Need for Instrumental Support, Need for Professional Support and Need for Community Support Network subscales. Fit to the Rasch model was obtained after removal of misfitting items. The Involvement in Care subscale had too few items to be adequately assessed by the Rasch approach. CONCLUSION The FNQ-R is a well-targeted instrument for assessing the unmet needs of caregivers regarding the need for health information, emotional support, professional support and a community support network after some scoring adjustment and the removal of misfitting items. Caution should be taken when comparing responses across countries.
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Affiliation(s)
- Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital , Oslo, Norway.,Institute of Clinical Medicine, University of Oslo , Oslo, Norway.,Center for Habilitation and Rehabilitation Research Models and Services, Institute of Health and Society, University of Oslo , Oslo, Norway
| | - Audny Anke
- Center for Habilitation and Rehabilitation Research Models and Services, Institute of Health and Society, University of Oslo , Oslo, Norway.,Department of Rehabilitation, University Hospital of North Norway , Tromso, Norway.,Faculty of Health Sciences, Department of Clinical Medicine, The Arctic University of Norway , Tromso, Norway
| | - Juan Carlos Arango-Lasprilla
- Biocruces Bizkaia Health Research Institute , Barakaldo, Spain.,IKERBASQUE. Basque Foundation for Science , Bilbao, Spain.,Department of Cell Biology and Histology, University of the Basque Country UPV/EHU , Leioa, Spain
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital , Oslo, Norway.,Center for Habilitation and Rehabilitation Research Models and Services, Institute of Health and Society, University of Oslo , Oslo, Norway
| | | | - Diego Rivera
- Department of Health Sciences, Public University of Navarre , Pamplona, Spain
| | - Anne Norup
- Department of Neurorehabilitation, TBI Unit , Copenhagen, Denmark.,Department of Psychology, University of Southern Denmark , Odense, Denmark
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Aydin K, Oren MM, Aydin T. Statistical concerns about the study: "Risk factors for polypharmacy in older adults in a primary care setting: a cross-sectional study". Clin Interv Aging 2018; 13:2539-2542. [PMID: 30587946 PMCID: PMC6298878 DOI: 10.2147/cia.s192184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Kubra Aydin
- Ataturk University School of Medicine, Department of Internal Medicine, Division of Nephrology, Ataturk University, Yakutiye 25100, Erzurum, Turkey,
| | - Meryem Merve Oren
- Istanbul University, Istanbul Medical School, Department of Public Health, Capa 34390, Istanbul, Turkey
| | - Tugba Aydin
- Istanbul Physical Medicine and Rehabilitation Training Hospital, Department of Physical Therapy and Rehabilitation, Bahcelievler 34188, Istanbul, Turkey
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Abstract
It has been more than 50 years ago, when in 1965 Florence Mahoney and Dorothea Barthel published an article entitled "Functional evaluation: the Barthel Index." Since then, Barthel scale, also known as a Basic ADL Index (BI), Barthel Score and Maryland Disability Index, is one of the most well-known scales ADL (Activities of Daily Living) and is still popular. This simple scale is still used by the representatives of a number of medical workers for many pur-poses, including the assessment of the results of treatment, rehabilitation, prognosing, assess-ment of self-reliance, assessment of needs for care and for the purposes of the judgment. De-spite its simplicity, the administration of the original Barthel questionnaire takes about 5-10 minutes; that`s why there is a demand for a shortened form of BI. Based on a review of the literature the advantages and disadvantages of the abbreviated BI versions in assessing activities of daily living has been presented.
Key Words
ADL, Barthel Index, Barthel scale, clinimetrics, short forms
Opara J. Are short forms of Barthel Index equally useful in the assessment of ADL? Med Rehabil 2018; 22(2): 40-44. DOI: 10.5604/01.3001.0012.6932
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Affiliation(s)
- Józef Opara
- Akademia Wychowania Fizycznego im. Jerzego Kukuczki w Katowicach / Jerzy Kukuczka Academy of Physical Education in Katowice, Poland
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Amegbor PM, Kuuire VZ, Robertson H, Kuffuor OA. Predictors of basic self-care and intermediate self-care functional disabilities among older adults in Ghana. Arch Gerontol Geriatr 2018; 77:81-88. [PMID: 29684742 DOI: 10.1016/j.archger.2018.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/05/2018] [Accepted: 04/05/2018] [Indexed: 10/17/2022]
Abstract
The number of older adults in Ghana is growing rapidly. Associated with this growth, is the rise in age-related chronic diseases such as cardiovascular and musculoskeletal conditions. However, there is limited knowledge in the Ghanaian context on the effect of chronic diseases on functional disabilities among older adults. In this study, we examine the association between chronic diseases, socioeconomic status, and functional disabilities. Data from 4107 Ghanaian older adults (persons aged 50 years and above) who participated in the World Health Organization's Global Ageing and Adult Health survey (SAGE-Wave 1) were used to fit random effect multivariate logistic and complementary log-log regression. Stroke was significantly associated with difficulty in performing both basic self-care functions and intermediate self-care functions. Hypertension and arthritis, on the other hand, were associated with basic self-care functional disability only. Socioeconomically vulnerable groups such as females, those with less education and low-incomes were more likely to have functional disabilities associated with basic self-care and intermediate self-care activities. In order to reduce functional disabilities among older persons in Ghana, efforts should be aimed at reducing chronic conditions as well as improving socioeconomic status.
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Affiliation(s)
- Prince M Amegbor
- Department of Geography and Planning, Queen's University, Mackintosh-Corry Hall, Room E208, Kingston, Ontario, K7L 3N6, Canada.
| | - Vincent Z Kuuire
- Department of Geography, University of Toronto Mississauga, William Davis Building, Room 3278, Mississauga, ON, L5L 1C6, Canada
| | | | - Oscar A Kuffuor
- Department of Geography and Planning, Queen's University, Mackintosh-Corry Hall, Room E208, Kingston, Ontario, K7L 3N6, Canada
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Oude Voshaar MAH, Ten Klooster PM, Vonkeman HE, van de Laar MAFJ. Measuring everyday functional competence using the Rasch assessment of everyday activity limitations (REAL) item bank. Qual Life Res 2017; 26:2949-2959. [PMID: 28638966 PMCID: PMC5655561 DOI: 10.1007/s11136-017-1627-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Traditional patient-reported physical function instruments often poorly differentiate patients with mild-to-moderate disability. We describe the development and psychometric evaluation of a generic item bank for measuring everyday activity limitations in outpatient populations. STUDY DESIGN AND SETTING Seventy-two items generated from patient interviews and mapped to the International Classification of Functioning, Disability and Health (ICF) domestic life chapter were administered to 1128 adults representative of the Dutch population. The partial credit model was fitted to the item responses and evaluated with respect to its assumptions, model fit, and differential item functioning (DIF). Measurement performance of a computerized adaptive testing (CAT) algorithm was compared with the SF-36 physical functioning scale (PF-10). RESULTS A final bank of 41 items was developed. All items demonstrated acceptable fit to the partial credit model and measurement invariance across age, sex, and educational level. Five- and ten-item CAT simulations were shown to have high measurement precision, which exceeded that of SF-36 physical functioning scale across the physical function continuum. Floor effects were absent for a 10-item empirical CAT simulation, and ceiling effects were low (13.5%) compared with SF-36 physical functioning (38.1%). CAT also discriminated better than SF-36 physical functioning between age groups, number of chronic conditions, and respondents with or without rheumatic conditions. CONCLUSION The Rasch assessment of everyday activity limitations (REAL) item bank will hopefully prove a useful instrument for assessing everyday activity limitations. T-scores obtained using derived measures can be used to benchmark physical function outcomes against the general Dutch adult population.
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Affiliation(s)
- Martijn A H Oude Voshaar
- Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands.
| | - Peter M Ten Klooster
- Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Harald E Vonkeman
- Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
- Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente, Enschede, The Netherlands
| | - Mart A F J van de Laar
- Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
- Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medical Spectrum Twente, Enschede, The Netherlands
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Evaluation of activities of daily living in patients with slowly progressive neuromuscular diseases. Neurol Neurochir Pol 2017; 52:222-227. [PMID: 29129380 DOI: 10.1016/j.pjnns.2017.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 10/18/2017] [Indexed: 11/21/2022]
Abstract
Slowly progressive neuromuscular diseases include but are not limited to: facioscapulohumeral muscular dystrophy (FSHD) and limb-girdle muscular dystrophy (LGMD), hereditary motor and sensory neuropathy (HMSN) and spinal muscular atrophy type III (SMA3). The purpose of this study is to present an evaluation of basic and complex activities of daily living in patients suffering from these diseases. The study was conducted on a group of 58 Polish patients: 25 patients with HMSN, 19 with LGMD and FSHD and 14 with SMA3. The research instrument consisted of two parts: a specially designed questionnaire and Nottingham Extended ADL Index. The survey was voluntary, anonymous and self-administered. In our study the highest scores on the NEADL scale were achieved by HMSN patients, and the lowest by patients with SMA3. The research revealed statistically significant differences between all the groups in the total number of points achieved on NEADL scale. The study revealed that for most respondents the most difficult tasks were those in the area of 'mobility'. It is consistent with reports in the literature, which confirm that out of the slowly progressive neuromuscular diseases included in this research, SMA3 is a disease leading to the biggest limitations in performing the activities of everyday life.
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9
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Reed R, Mehra M, Kirshblum S, Maier D, Lammertse D, Blight A, Rupp R, Jones L, Abel R, Weidner N, Curt A, Steeves J. Spinal cord ability ruler: an interval scale to measure volitional performance after spinal cord injury. Spinal Cord 2017; 55:730-738. [DOI: 10.1038/sc.2017.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 12/16/2016] [Accepted: 12/21/2016] [Indexed: 12/22/2022]
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10
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Kupzyk KA, Seo Y, Yates B, Pozehl B, Norman J, Lowes B. Use of the Late-Life Function and Disability Instrument for Measuring Physical Functioning in Patients With Heart Failure. J Nurs Meas 2016; 24:323-36. [PMID: 27535318 DOI: 10.1891/1061-3749.24.2.323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE We evaluated the psychometric properties of the functioning component of the Late-Life Function and Disability Instrument (LLFDI) in individuals with heart failure (HF). METHODS Factor analyses were used (N = 151) to assess the dimensionality and structure of the basic and advanced lower extremity function subscales. Rasch model scores were compared to the raw means of the items. RESULTS Rasch scores correlated with the raw means of the items at r = .96, indicating raw means are comparable to the more complicated Rasch analysis in estimating physical functioning using the basic and advanced subscales. CONCLUSIONS The lower extremity physical functioning subscales of the LLFDI have potential as a clinical assessment tool to identify HF patients who are at high risk for functional limitations.
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Affiliation(s)
- Kevin A Kupzyk
- College of Nursing, University of Nebraska Medical Center, Omaha
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11
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Vanstone AD, Wolf M, Poon T, Cuddy LL. Measuring engagement with music: development of an informant-report questionnaire. Aging Ment Health 2016; 20:474-84. [PMID: 25811870 DOI: 10.1080/13607863.2015.1021750] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study describes the development of the Music Engagement Questionnaire (MusEQ), a 35-item scale to measure engagement with music in daily life. Music has implications for well-being and for therapy, notably for individuals living with dementia. A number of excellent scales or questionnaires are now available to measure music engagement. Unlike these scales, the MusEQ may be completed by either the participant or an informant. METHOD Study 1 drew on a community-based sample of 391 participants. Exploratory factor analysis revealed six interpretable factors, which formed the basis for construction of six subscales. Study 2 applied the MusEQ to a group of participants with Alzheimer's disease (AD; n = 16) as well as a group of neurotypical older adults (OA; n = 16). Informants completed the MusEQ, and the OA group also completed the self-report version of the MusEQ. Both groups had an interview in which they described the place music had in their lives. These interviews were scored by three independent raters. RESULTS The MusEQ showed excellent internal consistency. Five of the factor-derived subscales showed good or excellent internal consistency. MusEQ scores were moderately correlated with a global rating of 'musicality' and with music education. There was strong agreement between self-report and informant-report data. MusEQ scores showed a significant positive relationship to independent ratings of music engagement. CONCLUSION The MusEQ provides a meaningful and reliable option for measuring music engagement among participants who are unable to complete a self-report questionnaire.
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Affiliation(s)
- Ashley D Vanstone
- a Department of Psychology , Queen's University at Kingston , Kingston , Canada
| | - Michael Wolf
- a Department of Psychology , Queen's University at Kingston , Kingston , Canada
| | - Tina Poon
- a Department of Psychology , Queen's University at Kingston , Kingston , Canada
| | - Lola L Cuddy
- a Department of Psychology , Queen's University at Kingston , Kingston , Canada
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12
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Abstract
When performing a novel task, people need to generate and apply a working strategy. The applicatio n of an appro priate working strategy enables patients with cognitive impairment (C I) to perform tasks efficiently, which in turn makes it easier to meet the challenges of daily life tasks. We investigated the strategy application abilities (SAA) of multiple sclerosis (MS) patients and compared these results with data based on healthy subjects’ performance. Seventy-six patients performed a Strategy A pplication Test (SAT) along with other cognitive tests, and completed depression, fatigue, and activity of daily living (A DL) questionnaires. O ur results indicated that 76% of the MS patients included had impaired SAA, and that this impairment was not correlated with their depression, fatigue, Expanded Disability Severity Scale (EDSS), or A DL. These findings may have important implications for the understanding of the capability of MS patients to cope with nonroutine tasks, as well as for the potential of future implementation of cognitive rehabilitation in improving the SAA of patients with MS or other cognitive disorders.
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Affiliation(s)
- Smadar Birnboim
- The Center of Multiple Sclerosis and Brain Research, Carmel Medical Center, Haifa, Israel
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13
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Standardisation of the Test Your Memory and evaluation of their concordance with the outcome of the psychometric examination. NEUROLOGÍA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.nrleng.2015.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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14
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Toward the processing speed theory of activities of daily living in healthy aging: normative data of the Functional Activities Questionnaire. Aging Clin Exp Res 2016; 28:239-47. [PMID: 26231091 DOI: 10.1007/s40520-015-0413-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 07/03/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The aim of this study was to describe an instrumental activities of daily living (IADL) measure: Functional Activities Questionnaire (FAQ), which is often used in clinical settings as a self- or informant-based measure of IADL. However, the FAQ's relationship with age or education in healthy aging has not been investigated. METHODS FAQ and a neuropsychological battery were administered to old and very old Czech adults (n = 540). Participants met strict inclusion criteria for the absence of any active or past neurodegenerative disorders. RESULTS FAQ is significantly dependent on age and education, but not gender. Younger subjects and those with higher education have the lowest scores in the FAQ and show a higher degree of functional independence. FAQ moderately correlates with speed of processing, visual-perceptual and executive functions measures (Trail Making Tests, Stroop Test) and depressive symptoms, but not with episodic memory (WMS-III logical memory). We present normative percentile values for different age groups from 60 to 96 years of age. CONCLUSIONS The present study shows conclusively that IADL measures, such as FAQ, should not be used without appropriate normative data, especially in very old adults. Thus, it has the ability to differentiate functional dependence due to age-related decline from neurodegenerative disease.
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Lutomski JE, Krabbe PFM, den Elzen WPJ, Olde-Rikkert MGM, Steyerberg EW, Muntinga ME, Bleijenberg N, Kempen GIJM, Melis RJF. Rasch analysis reveals comparative analyses of activities of daily living/instrumental activities of daily living summary scores from different residential settings is inappropriate. J Clin Epidemiol 2015; 74:207-17. [PMID: 26597973 DOI: 10.1016/j.jclinepi.2015.11.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 10/25/2015] [Accepted: 11/05/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To internally validate a 15-item dichotomous activities of daily living (ADL) and instrumental activities of daily living (IADL) index. STUDY DESIGN AND SETTING Data were extracted from The Older Persons and Informal Caregivers Survey Minimum DataSet (TOPICS-MDS). Using Rasch modeling, six aspects of the ADL/IADL scale were assessed: (1) overall fit, (2) internal consistency, (3) individual item and person fit, (4) local dependency, (5) targeting, and (6) differential item functioning (DIF) (RUMM 2030). All analyses were stratified by living situation [community-dwelling (n = 21,926) or residential care facility (n = 2,458)]. RESULTS In both settings, "eating" was the easiest activity on the scale and "performing household tasks" was the most difficult activity. However, based on the location on the logit scale, the level of difficulty for certain items varied between residential settings, suggesting summary scores are not equivalent between these settings. DIF by gender and age group was observed for several items, indicating potential measurement bias in the scale. CONCLUSION Unless adjustments are undertaken, ADL/IADL summary scores retrieved from older persons residing in the community or residential care facilities should not be directly compared. This 15-item scale is poorly targeted for a community-dwelling older population, underscoring the need for items with improved discriminative ability.
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Affiliation(s)
- Jennifer E Lutomski
- Department of Geriatric Medicine, Radboud University Medical Center, Reinier Postlaan 4, 6525 CG Nijmegen, The Netherlands; National Perinatal Epidemiology Centre, 5(th) Floor, Cork University Maternity Hospital, Wilton, Cork, Ireland.
| | - Paul F M Krabbe
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Wendy P J den Elzen
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, 2333 RC Leiden, The Netherlands
| | - Marcel G M Olde-Rikkert
- Department of Geriatric Medicine, Radboud University Medical Center, Reinier Postlaan 4, 6525 CG Nijmegen, The Netherlands
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus University Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Maaike E Muntinga
- Department of General Practice and Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Nienke Bleijenberg
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitweg 100, 3584 CG Utrecht, The Netherlands
| | - Gertrudis I J M Kempen
- Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, Duboisdomein 30, 6229 GT Maastricht, The Netherlands
| | - René J F Melis
- Department of Geriatric Medicine, Radboud University Medical Center, Reinier Postlaan 4, 6525 CG Nijmegen, The Netherlands
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Ferrero-Arias J, Turrión-Rojo MA. [Standardization of the Test Your Memory and evaluation of their concordance with the outcome of the psychometric examination]. Neurologia 2015; 31:239-46. [PMID: 26059809 DOI: 10.1016/j.nrl.2015.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 03/21/2015] [Accepted: 03/24/2015] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To explore the relationship between scores on the Test Your Memory (TYM) battery and findings from a more exhaustive neurocognitive assessment. METHODS The TYM and fourteen psychometric tests were administered to 84 subjects aged 50 or older who attended an outpatient neurology clinic due to cognitive symptoms. Each patient's cognitive state was determined independently from his/her score on the TYM (CDR 0, n=25; CDR 0.5, n=45; CDR 1, n=14). We analysed concurrent validity of TYM scores and results from the psychometric tests, as well as the degree of concordance between the two types of measurement, by contrasting normalised data from each instrument. RESULTS Although the intraclass correlation coefficient was 0.67 (confidence interval 95%, 0.53-0.77), analysis of the Bland-Altman plot and the curve on the survival-agreement plot (Luiz et al. method) demonstrates that the individual distances between the two methods exhibit excessive dispersion from a clinical viewpoint. TYM-based predictions of the mean z-score on psychometric tests differed substantially from real results in 30% of the subjects. Concordance of 95% can only be achieved by accepting absolute inter-instrument differences of up to 0.87 as identical values. Furthermore, the TYM underestimates cognitive performance for low values and overestimates it for high values. CONCLUSIONS The TYM is a cognitive screening test which should not be used to predict results on psychometric tests or to detect cognitive changes in clinical trials.
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Sousa LB, Prieto G, Vilar M, Firmino H, Simões MR. The Adults and Older Adults Functional Assessment Inventory. Res Aging 2014; 37:787-814. [DOI: 10.1177/0164027514564469] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Functional assessment methods are an important element in multidimensional neuropsychological evaluations, particularly in older adults. The Adults and Older Adults Functional Assessment Inventory is a new measure of basic and instrumental activities of daily living. Rasch model analyses were used to analyze the psychometric characteristics of the instrument in a sample of 803 participants. The original categories did not provide an optimal assessment of functional incapacity. The scale was dichotomized to achieve a better reliability score and item fit. The final 50 items revealed a moderately high variability in item difficulty, acceptable fits to items and persons, and a good Person Separation Reliability score. The scores were able to discriminate between normal controls and clinical patients. None of the items showed Differential Item Functioning associated with age, gender, or education. The instrument is able to achieve measures of functional incapacity with the useful properties of the Rasch model.
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Affiliation(s)
- Liliana B. Sousa
- Centro de Investigação do Núcleo de Estudos e Intervenção Cognitivo Comportamental, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Gerardo Prieto
- Faculty of Psychology, University of Salamanca, Salamanca, Spain
| | - Manuela Vilar
- Centro de Investigação do Núcleo de Estudos e Intervenção Cognitivo Comportamental, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Horácio Firmino
- Psychogeriatric Unit, Department of Psychiatry, Coimbra University Hospital, Portugal
| | - Mário R. Simões
- Centro de Investigação do Núcleo de Estudos e Intervenção Cognitivo Comportamental, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
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A new informant‐based questionnaire for instrumental activities of daily living in dementia. Alzheimers Dement 2012; 8:536-43. [DOI: 10.1016/j.jalz.2011.08.006] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 08/08/2011] [Accepted: 08/12/2011] [Indexed: 11/24/2022]
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A warning index used in prescreening for Alzheimer's disease, based on self-reported cognitive deficits and vascular risk factors for dementia in elderly patients with type 2 diabetes. Int J Alzheimers Dis 2012; 2012:124215. [PMID: 23119223 PMCID: PMC3478737 DOI: 10.1155/2012/124215] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 09/09/2012] [Accepted: 09/10/2012] [Indexed: 11/17/2022] Open
Abstract
Background/Aims. Diabetes might increase the risk of Alzheimer's disease (AD). For detecting dementia, it is typical to obtain informants' perceptions of cognitive deficits, but such interviews are usually difficult in routine care. We aimed to develop a model for predicting mild to moderate AD using a self-reported questionnaire and by evaluating vascular risk factors for dementia in elderly subjects with diabetes. Methods. We recruited 286 diabetic and 155 nondiabetic elderly subjects. There were 25 patients with AD and 261 cognitively normal individuals versus 30 with AD and 125 normal subjects, respectively. Each participant answered subjective questions on memory deficits and daily functioning. Information on vascular risk factors was obtained from clinical charts, and multivariate logistic regression was used to develop a model for predicting AD. Results. The predicted probabilities used in screening for AD in diabetic subjects constituted age, education, lower diastolic blood pressure, subjective complaints of memory dysfunction noticeable by others, and impaired medication, shopping, and travel outside a familiar locality. Receiver operating characteristic analysis revealed a satisfactory discrimination for AD specific for diabetic elderly subjects, with 95.2% sensitivity and 90.6% specificity. Conclusion. This is the first useful index that can prescreen for AD in elderly subjects with diabetes.
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Hofhuis JGM, Dijkgraaf MGW, Hovingh A, Braam RL, van de Braak L, Spronk PE, Rommes JH. The Academic Medical Center Linear Disability Score for evaluation of physical reserve on admission to the ICU: can we query the relatives? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2011; 15:R212. [PMID: 21917138 PMCID: PMC3334756 DOI: 10.1186/cc10447] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 07/11/2011] [Accepted: 09/14/2011] [Indexed: 01/22/2023]
Abstract
Introduction Evaluating the pre-morbid functional status in critically ill patients is important and frequently done using the physical component score (PCS) of the Short Form 36, although this approach has its limitations. The Academic Medical Center Linear Disability Score (ALDS) is a recently developed generic item bank used to measure the disability status of patients with a broad range of diseases. We aimed to study whether proxy scoring with the ALDS could be used to assess the patients' functional status on admission for cardiac care unit (CCU) or ICU patients and how the ALDS relates to the PCS using the Short Form 12 (SF-12). Methods Patients and proxies completed the ALDS and SF-12 score in the first 72 hours following ICU scheduled surgery (n = 14), ICU emergency admission (n = 56) and CCU emergency admission (n = 70). Results In all patients (n = 140) a significant intra-class correlation was found for the ALDS (0.857), the PCS (0.798) and the mental component score (0.679) between patients and their proxy. In both scheduled and emergency admissions, a significant correlation was found between patients and their proxy for the ALDS, although the lowest correlation was found for the ICU scheduled admissions (0.755) compared with the ICU emergency admissions (0.889). In CCU patients, the highest significant correlation between patients and proxies was found for the ALDS (0.855), for the PCS (0.807) and for the mental component score (0.740). Conclusions Relatives in close contact with critically ill patients can adequately reflect the patient's level of disability on ICU and CCU admission when using the ALDS item bank, which performed at least as well as the PCS. The ALDS could therefore be a useful alternative for the PCS of the SF-12.
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Affiliation(s)
- José G M Hofhuis
- Department of Intensive Care, Gelre Hospital, Apeldoorn, Albert Schweitzerlaan 31, 7334 DZ Apeldoorn, the Netherlands.
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Wu CY, Chuang LL, Lin KC, Lee SD, Hong WH. Responsiveness, Minimal Detectable Change, and Minimal Clinically Important Difference of the Nottingham Extended Activities of Daily Living Scale in Patients With Improved Performance After Stroke Rehabilitation. Arch Phys Med Rehabil 2011; 92:1281-7. [DOI: 10.1016/j.apmr.2011.03.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 03/01/2011] [Accepted: 03/07/2011] [Indexed: 10/17/2022]
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Leung DYP, Leung AYM, Chi I. An Evaluation of the Factor Structure of the Instrumental Activities of Daily Living Involvement and Capacity Scales of the Minimum Data Set for Home Care for Elderly Chinese Community Dwellers in Hong Kong. Home Health Care Serv Q 2011; 30:147-59. [DOI: 10.1080/01621424.2011.592421] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Cavaletti G, Alberti P, Marmiroli P. Chemotherapy-induced peripheral neurotoxicity in the era of pharmacogenomics. Lancet Oncol 2011; 12:1151-61. [PMID: 21719347 DOI: 10.1016/s1470-2045(11)70131-0] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Development of advanced and high-throughput methods to study variability in human genes means we can now use pharmacogenomic analysis not only to predict response to treatment but also to assess the toxic action of drugs on normal cells (so-called toxicogenomics). This technological progress could enable us to identify individuals at high and low risk for a given side-effect. Pharmacogenomics could be very useful for stratification of cancer patients at risk of developing chemotherapy-induced peripheral neurotoxicity, one of the most severe and potentially permanent non-haematological side-effects of modern chemotherapeutic agents. However, study data reported so far are inconsistent, which suggests that methodological improvement is needed in clinical trials to obtain reliable results in this clinically relevant area.
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Affiliation(s)
- Guido Cavaletti
- Department of Neuroscience and Biomedical Technologies, University of Milano-Bicocca, Monza, Italy.
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Emesis and gastrointestinal problems during radiotherapy: A comparison of performance of daily activities between patients experiencing nausea and patients free from nausea. Eur J Oncol Nurs 2010; 14:359-66. [DOI: 10.1016/j.ejon.2009.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Revised: 10/20/2009] [Accepted: 10/23/2009] [Indexed: 11/23/2022]
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Goldberg TE, Koppel J, Keehlisen L, Christen E, Dreses-Werringloer U, Conejero-Goldberg C, Gordon ML, Davies P. Performance-based measures of everyday function in mild cognitive impairment. Am J Psychiatry 2010; 167:845-53. [PMID: 20360320 PMCID: PMC2900829 DOI: 10.1176/appi.ajp.2010.09050692] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The view that everyday function is preserved in mild cognitive impairment may be problematic. The objectives of this study were to determine the magnitude of impairment in everyday function in patients with mild cognitive impairment and Alzheimer's disease using a novel sensitive performance-based measure (the UCSD Performance-Based Skills Assessment; UPSA), contrast it with use of an informant-based measure (the Alzheimer's Disease Cooperative Study-Activities of Daily Living Inventory; ADCS-ADL), and model the relationship between cognitive measures and the performance-based measure. METHOD Fifty cognitively normal elders, 26 patients who met criteria for amnestic mild cognitive impairment, and 22 patients who suffered from mild to moderate Alzheimer's disease were assessed on the UPSA, the ADCS-ADL, and a battery of neurocognitive tests. RESULTS Patients with mild cognitive impairment had significant impairments on the UPSA but not on the ADCS-ADL. The magnitude of the effect size between the cognitively healthy and the mild cognitive impairment group for the UPSA was large (d=0.86). A strong and significant relationship was observed between cognitive performances in speed (R(2)=0.37), episodic memory (R(2)=0.10), and semantic processing (R(2)=0.03) and UPSA score using multiple regression models. The psychometric properties of the UPSA were acceptable, as were its sensitivity and specificity in contrasts between cognitively normal elders and patients with mild cognitive impairment and between the latter group and patients with Alzheimer's disease. CONCLUSIONS These findings indicate that performance-based measures of function may be a sensitive tool in studies of Alzheimer's disease and mild cognitive impairment and suggest the need for a reconceptualization of the relationship between cognition and function in mild cognitive impairment so that they can be usefully aligned.
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Dokumentation, Messung und Qualitätsmanagement. NeuroRehabilitation 2010. [DOI: 10.1007/978-3-642-12915-5_43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Weisscher N, Glas CA, Vermeulen M, De Haan RJ. The use of an item response theory-based disability item bank across diseases: accounting for differential item functioning. J Clin Epidemiol 2009; 63:543-9. [PMID: 19880281 DOI: 10.1016/j.jclinepi.2009.07.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Revised: 07/24/2009] [Accepted: 07/28/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVE There is not a single universally accepted activity of daily living (ADL) instrument available to compare disability assessments across different patient groups. We developed a generic item bank of ADL items using item response theory, the Academic Medical Center Linear Disability Scale (ALDS). When comparing outcomes of the ALDS between patients groups, item characteristics of the ALDS should be comparable across groups. The aim of the study was to assess the differential item functioning (DIF) in a group of patients with various disorders to investigate the comparability across these groups. STUDY DESIGN AND SETTING Cross-sectional, multicenter study including 1,283 in- and outpatients with a variety of disorders and disability levels. The sample was divided in two groups: (1) mainly neurological patients (n=497; vascular medicine, Parkinson's disease and neuromuscular disorders) and (2) patients from internal medicine (n=786; pulmonary diseases, chronic pain, rheumatoid arthritis, and geriatric patients). RESULTS Eighteen of 72 ALDS items showed statistically significant DIF (P<0.01). However, the DIF could effectively be modeled by the introduction of disease-specific parameters. CONCLUSION In the subgroups studied, DIF could be modeled in such a way that the ensemble of the items comprised a scale applicable in both groups.
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Affiliation(s)
- Nadine Weisscher
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Dubuc N, Haley S, Ni P, Kooyoomjian J, Jette A. Function and disability in late life: comparison of the Late-Life Function and Disability Instrument to the Short-Form-36 and the London Handicap Scale. Disabil Rehabil 2009; 26:362-70. [PMID: 15204488 DOI: 10.1080/09638280410001658667] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE We evaluated the Late-Life Function and Disability Instrument's (LLFDI) concurrent validity, comprehensiveness and precision by comparing it with the Short-Form-36 physical functioning (PF-10) and the London Handicap Scale (LHS). METHODS We administered the LLFDI, PF-10 and LHS to 75 community-dwelling adults (> 60 years of age). We used Pearson correlation coefficients to examine concurrent validity and Rasch analysis to compare the item hierarchies, content ranges and precision of the PF-10 and LLFDI function domains, and the LHS and the LLFDI disability domains. RESULTS LLFDI Function (lower extremity scales) and PF-10 scores were highly correlated (r = 0.74 - 0.86, p > 0.001); moderate correlations were found between the LHS and the LLFDI Disability limitation (r = 0.66, p < 0.0001) and Disability frequency (r = 0.47, p < 0.001) scores. The LLFDI had a wider range of content coverage, less ceiling effects and better relative precision across the spectrum of function and disability than the PF-10 and the LHS. The LHS had slightly more content range and precision in the lower end of the disability scale than the LLFDI. CONCLUSIONS The LLFDI is a more comprehensive and precise instrument compared to the PF-10 and LHS for assessing function and disability in community-dwelling older adults.
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Affiliation(s)
- Nicole Dubuc
- Center for Rehabilitation Effectiveness, Sargent College of Health and Rehabilitation Sciences, Boston University, MA 02215, USA
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Pollack MM, Holubkov R, Glass P, Dean JM, Meert KL, Zimmerman J, Anand KJS, Carcillo J, Newth CJL, Harrison R, Willson DF, Nicholson C. Functional Status Scale: new pediatric outcome measure. Pediatrics 2009; 124:e18-28. [PMID: 19564265 PMCID: PMC3191069 DOI: 10.1542/peds.2008-1987] [Citation(s) in RCA: 269] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The goal was to create a functional status outcome measure for large outcome studies that is well defined, quantitative, rapid, reliable, minimally dependent on subjective assessments, and applicable to hospitalized pediatric patients across a wide range of ages and inpatient environments. METHODS Functional Status Scale (FSS) domains of functioning included mental status, sensory functioning, communication, motor functioning, feeding, and respiratory status, categorized from normal (score = 1) to very severe dysfunction (score = 5). The Adaptive Behavior Assessment System II (ABAS II) established construct validity and calibration within domains. Seven institutions provided PICU patients within 24 hours before or after PICU discharge, high-risk non-PICU patients within 24 hours after admission, and technology-dependent children. Primary care nurses completed the ABAS II. Statistical analyses were performed. RESULTS A total of 836 children, with a mean FSS score of 10.3 (SD: 4.4), were studied. Eighteen percent had the minimal possible FSS score of 6, 44% had FSS scores of >or=10, 14% had FSS scores of >or=15, and 6% had FSS scores of >or=20. Each FSS domain was associated with mean ABAS II scores (P < .0001). Cells in each domain were collapsed and reweighted, which improved correlations with ABAS II scores (P < .001 for improvements). Discrimination was very good for moderate and severe dysfunction (ABAS II categories) and improved with FSS weighting. Intraclass correlations of original and weighted total FSS scores were 0.95 and 0.94, respectively. CONCLUSIONS The FSS met our objectives and is well suited for large outcome studies.
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Affiliation(s)
- Murray M. Pollack
- Department of Pediatrics, Children's National Medical Center, Washington, DC
| | - Richard Holubkov
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Penny Glass
- Department of Pediatrics, Children's National Medical Center, Washington, DC
| | - J. Michael Dean
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Kathleen L. Meert
- Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan
| | - Jerry Zimmerman
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
| | | | - Joseph Carcillo
- Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Rick Harrison
- Department of Pediatrics, University of California, Los Angeles, California
| | - Douglas F. Willson
- Department of Pediatrics, University of Virginia Children's Hospital, Charlottesville, Virginia
| | - Carol Nicholson
- Department of Pediatrics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
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Reig-Ferrer A, Cabrero-García J, Lizán Tudela L. [Assessment of functional capacity, psychological well-being and mental health in primary care]. Aten Primaria 2009; 41:515-519. [PMID: 19427712 DOI: 10.1016/j.aprim.2008.10.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Accepted: 10/20/2008] [Indexed: 11/28/2022] Open
Affiliation(s)
- Abilio Reig-Ferrer
- Departamento de Psicología de la Salud, Universidad de Alicante, Alicante, España.
| | | | - Luis Lizán Tudela
- Outcomes Research Group, Departamento de Economía, Universidad Jaime I, España; Unidad Docente de Medicina de Familia, Castellón, España
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Executive dysfunction correlates with impaired functional status in older adults with varying degrees of cognitive impairment. Int Psychogeriatr 2008; 20:1104-15. [PMID: 18752698 DOI: 10.1017/s1041610208007631] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Previous studies have reported an association between executive dysfunction and the ability to perform activities of daily living (ADL)s among older adults. This study aims to examine the association between executive functions and functional status in a cross-section of older adults with varying degrees of cognitive impairment. METHODS 89 individuals (mean age 73.8 years) were recruited at a memory clinic in São Paulo, Brazil. Subjects underwent evaluation, and were allocated into three diagnostic groups according to cognitive status: normal controls (NC, n = 32), mild cognitive impairment (MCI, n = 31) and mild Alzheimer's disease (AD, n = 26). Executive functions were assessed with the 25-item Executive Interview (EXIT25), and functional status was measured with the Direct Assessment of Functional Status test (DAFS-R). RESULTS Significantly different total DAFS-R scores were observed across the three diagnostic groups. Patients with AD performed significantly worse in EXIT25 compared with subjects without dementia, and no significant differences were detected between NC and MCI patients. We found a robust negative correlation between the DAFS-R and the EXIT25 scores (r =-0.872, p < 0.001). Linear regression analyses suggested a significant influence of the EXIT-25 and the CAMCOG on the DAFS-R scores. CONCLUSION Executive dysfunction and decline in general measures of cognitive functioning are associated with a lower ability to undertake instrumental ADLs. MCI patients showed worse functional status than NC subjects. MCI patients may show subtle changes in functional status that may only be captured by objective measures of ADLs.
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Enblom A, Bergius Axelsson B, Steineck G, Hammar M, Börjeson S. One third of patients with radiotherapy-induced nausea consider their antiemetic treatment insufficient. Support Care Cancer 2008; 17:23-32. [DOI: 10.1007/s00520-008-0445-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2007] [Accepted: 03/13/2008] [Indexed: 11/30/2022]
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van Nes SI, Faber CG, Merkies ISJ. Outcome measures in immune-mediated neuropathies: the need to standardize their use and to understand the clinimetric essentials. J Peripher Nerv Syst 2008; 13:136-47. [DOI: 10.1111/j.1529-8027.2008.00169.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Post B, Speelman JD, de Haan RJ. Clinical heterogeneity in newly diagnosed Parkinson’s disease. J Neurol 2008; 255:716-22. [PMID: 18344057 DOI: 10.1007/s00415-008-0782-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2006] [Revised: 10/10/2007] [Accepted: 10/16/2007] [Indexed: 11/29/2022]
Affiliation(s)
- Bart Post
- Dept. of Neurology and Clinical Neurophysiology, Academic Medical Center, Amsterdam, The Netherlands.
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Weisscher N, Vermeulen M, Roos YB, de Haan RJ. What should be defined as good outcome in stroke trials; a modified Rankin score of 0-1 or 0-2? J Neurol 2008; 255:867-74. [PMID: 18338195 DOI: 10.1007/s00415-008-0796-8] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2007] [Revised: 10/22/2007] [Accepted: 10/29/2007] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Good outcome in stroke trials has been defined as a modified Rankin scale (mRs) score of 0-1 or 0-2. The aim of this study was to investigate the clinical meaning of these two dichotomies. METHODS We studied 152 patients six months post stroke using the mRs and a new disability measure the AMC Linear Disability Scale (ALDS) item bank. Descriptive statistics were used to show the ALDS scores by the levels of the mRs. To investigate the clinical meaning of the different definitions of good outcome, the mean probability to perform activities of daily life (ADL) of all mRs grades and these two dichotomies was calculated. RESULTS The ability to perform difficult ALDS items declined gradually with increasing mRs grade. When favourable outcome is defined as mRs 0-1, 15 % of the cohort has a good outcome; of these patients 84 % were likely to perform outdoor activities. If good outcome is defined as mRs 0-2, the percentage of patients with good outcome increased to 37 %, whereas 66 % of these patients were likely to perform outdoor activities. CONCLUSION If good outcome is defined as the ability to perform outdoor activities mRs 0-1 should be chosen. If complex ADL are considered as good outcome mRs 0-2 is the outcome measure of choice. Independent of which outcome measure is chosen, the treatment effect in clinical trials must be large before good outcome is achieved. Therefore, it is likely that clinically important treatment effects can be missed in clinical trials with both these mRs endpoints.
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Affiliation(s)
- N Weisscher
- Dept. of Neurology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Cabrero-García J, López-Pina JA. Aggregated measures of functional disability in a nationally representative sample of disabled people: analysis of dimensionality according to gender and severity of disability. Qual Life Res 2008; 17:425-36. [PMID: 18264797 DOI: 10.1007/s11136-008-9313-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2007] [Accepted: 01/15/2008] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine (i) the dimensional invariance of instrumental and basic activities of daily living (IADL/ADL) by gender subgroups, and (ii) the extent to which ADL dimensionality varies with the inclusion or exclusion of nondisabled people. METHODS Data were taken from the 1999 Spanish Survey on Disability, Impairment and State of Health. The analysis focussed on 6,522 people aged over 65 years who received help to perform or were unable to perform IADL/ADL items. Unidimensional and multidimensional item response theory (IRT) models were applied to this sample. RESULTS In the female sample, IADL/ADL items formed a scale with sufficient unidimensionality to fit a two-parameter logistic IRT model. In the male sample, the structure was bidimensional: self-care and mobility, and household activities. When the sample was composed of IADL/ADL disabled people, ADL items formed a unidimensional scale; when it was composed only of ADL disabled people, they formed a bidimensional structure: self-care and mobility. CONCLUSIONS IADL/ADL items can be combined in a single scale to measure severity of functional disability in females, but not in males. Separate aggregated scores must be considered for each subdomain, basic mobility and self-care, in order to measure the severity of ADL disability.
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Affiliation(s)
- Julio Cabrero-García
- Department of Nursing, University of Alicante, Campus de San Vicente del Raspeig, Ap. 99, 03080 Alicante, Spain.
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Cook C, Goode A, Erb D, Richardson J, Pietrobon R. Validation of an Item Bank in a Sample of Community-Dwelling Survivors of a Stroke. J Geriatr Phys Ther 2006; 29:107-14. [PMID: 17381853 DOI: 10.1519/00139143-200612000-00005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE The purpose of this study was to validate an item bank of questions associated with activities of daily living (ADL), using graded item response theory (G-IRT), in a sample of community-dwelling survivors of a stroke. METHODS The study sample consisted of 364 community-dwelling individuals who reported a recent history of stroke. Sixteen line items from the 1999-2000 National Health and Nutrition Examination Surveys (NHANES) survey were analyzed using factor analysis, internal analyses of consistency, and G-IRT. RESULTS The 16 line items demonstrated unidimensionality and were internally reliable. Thirteen line items demonstrated good discrimination and suitable thresholds. The majority of items exhibited appropriate sensitivity across the entire spectrum of functional severity indicating that these items closely reflected the relationship of decreased function with increased severity of illness. CONCLUSION Each of the 13 items is scale independent, is valid for measurement of functional impairment, and may be applicable for use in a scale for assessment of functional change in community-dwelling stroke survivors.
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Affiliation(s)
- Chad Cook
- Division of Physical Therapy, Duke University, DUMC 3907, Durham, NC 27710, USA. chad.cook@ duke.edu
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Magy L. Dixièmes Journées des Maladies du Système Nerveux Périphérique Quoi de neuf depuis 10 ans dans l’évaluation des neuropathies périphériques? Rev Neurol (Paris) 2006; 162:1279-83. [PMID: 17151524 DOI: 10.1016/s0035-3787(06)75146-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In the past ten years, clinical evaluation of peripheral neuropathy has greatly improved, thanks to the development and validation of new evaluation tools. Notably, new functional scales that may be used in clinical trials as well as in daily practice have emerged. This evolution is remarkable, but will necessitate considerable efforts from Neurologists in their clinical practice. In the field of electrophysiological examination, techniques have not evolved as much in the past ten years. However, interpretation of abnormal results leading to the diagnosis of immune mediated peripheral neuropathies has improved, allowing the development of new rationales for diagnostic strategies.
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Affiliation(s)
- L Magy
- Service de Neurologie, CHRU Dupuytren, Limoges.
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Abstract
The usefulness of functional scales has become clear in the past few years, to evaluate patients with dysimmune peripheral neuropathies. Functional scales which measure the real impact of the disease process in our patients will probably be increasingly used in future therapeutic trials. By contrast with neurological disorders leading to pure motor involvement, peripheral neuropathies are difficult to evaluate, due to their clinical polymorphism. However, efforts have been made in the past ten years in order to validate functional scales that may be routinely used by neurologists for dysimmune neuropathies. New scales will probably arise in the next few years, to be used in neuropathies from other causes. These scales will have to be strictly validated to be used in the daily medical practice.
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Affiliation(s)
- L Magy
- Service de Neurologie, CHRU Dupuytren, Limoges.
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Vittengl JR, White CN, McGovern RJ, Morton BJ. Comparative validity of seven scoring systems for the instrumental activities of daily living scale in rural elders. Aging Ment Health 2006; 10:40-7. [PMID: 16338813 DOI: 10.1080/13607860500307944] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Lawton and Brody's eight-item Instrumental Activities of Daily Living (IADL) scale is used often with elderly patients but scored in several different ways. We scored the IADL with seven popular procedures ranging from relatively simple to complex (Guttman scores, summed and Rasch scores from dichotomous, trichotomous, and polytomous items) in a sample of rural elders (N = 231). We compared the IADL scales' prediction of concurrent cognitive functioning, depressive symptoms, psychosocial functioning, and health care use (medications, outpatient visits, inpatient days). Validity coefficients ranged from small to large among outcome variables but were highly consistent across IADL scoring procedures. Consequently, researchers and clinicians may prefer to use simpler IADL scoring procedures with this population.
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Affiliation(s)
- J R Vittengl
- Division of Social Science, Truman State University, Kirksville, MO 63501-4221, USA.
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Holman R, Weisscher N, Glas CAW, Dijkgraaf MGW, Vermeulen M, de Haan RJ, Lindeboom R. The Academic Medical Center Linear Disability Score (ALDS) item bank: item response theory analysis in a mixed patient population. Health Qual Life Outcomes 2005; 3:83. [PMID: 16381611 PMCID: PMC1327691 DOI: 10.1186/1477-7525-3-83] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2005] [Accepted: 12/29/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Currently, there is a lot of interest in the flexible framework offered by item banks for measuring patient relevant outcomes. However, there are few item banks, which have been developed to quantify functional status, as expressed by the ability to perform activities of daily life. This paper examines the measurement properties of the Academic Medical Center linear disability score item bank in a mixed population. METHODS This paper uses item response theory to analyse data on 115 of 170 items from a total of 1002 respondents. These were: 551 (55%) residents of supported housing, residential care or nursing homes; 235 (23%) patients with chronic pain; 127 (13%) inpatients on a neurology ward following a stroke; and 89 (9%) patients suffering from Parkinson's disease. RESULTS Of the 170 items, 115 were judged to be clinically relevant. Of these 115 items, 77 were retained in the item bank following the item response theory analysis. Of the 38 items that were excluded from the item bank, 24 had either been presented to fewer than 200 respondents or had fewer than 10% or more than 90% of responses in the category 'can carry out'. A further 11 items had different measurement properties for younger and older or for male and female respondents. Finally, 3 items were excluded because the item response theory model did not fit the data. CONCLUSION The Academic Medical Center linear disability score item bank has promising measurement characteristics for the mixed patient population described in this paper. Further studies will be needed to examine the measurement properties of the item bank in other populations.
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Affiliation(s)
- Rebecca Holman
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | - Nadine Weisscher
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | - Cees AW Glas
- Department of Educational Measurement, University of Twente, Enschede, The Netherlands
| | - Marcel GW Dijkgraaf
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands
- Department of Anesthesiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Marinus Vermeulen
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | - Rob J de Haan
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | - Robert Lindeboom
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands
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Holman R, Glas CAW. Modelling non-ignorable missing-data mechanisms with item response theory models. THE BRITISH JOURNAL OF MATHEMATICAL AND STATISTICAL PSYCHOLOGY 2005; 58:1-17. [PMID: 15969835 DOI: 10.1111/j.2044-8317.2005.tb00312.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
A model-based procedure for assessing the extent to which missing data can be ignored and handling non-ignorable missing data is presented. The procedure is based on item response theory modelling. As an example, the approach is worked out in detail in conjunction with item response data modelled using the partial credit and generalized partial credit models. Simulation studies are carried out to assess the extent to which the bias caused by ignoring the missing-data mechanism can be reduced. Finally, the feasibility of the procedure is demonstrated using data from a study to calibrate a medical disability scale.
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Affiliation(s)
- Rebecca Holman
- Department of Clinical Epidemiology and Biostatistics, Amsterdam Medical Center, The Netherlands.
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Gauggel S, Böcker M, Zimmermann P, Privou C, Lutz D. Item-response-Theorie und deren Anwendung in der Neurologie. DER NERVENARZT 2004; 75:1179-86. [PMID: 15586265 DOI: 10.1007/s00115-004-1734-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This article is concerned with the measurement of activity limitations in neurologic patients and with the application of the item response theory (IRT), especially the Rasch analysis, in analyzing activity ratings. Activity limitations of 166 patients with different neurologic disorders (e.g., stroke, traumatic brain injury) were assessed with the Functional Independence Measure (FIM) during their stay in a rehabilitation hospital. Data analysis was performed with the Rasch model, which allows testing the psychometric qualities of the FIM. Results indicate that the FIM has good psychometric qualities. However, results also show that the 18 FIM items define two statistically and clinically different indicators. Thirteen items define disability in motor functions. Five items define disability in cognitive functions. Separate analyses of the two scales help to improve the psychometric quality of the FIM.
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Affiliation(s)
- S Gauggel
- Institut für Psychologie, TU Chemnitz, Chemnitz.
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Holman R, Lindeboom R, Vermeulen M, de Haan RJ. The AMC Linear Disability Score project in a population requiring residential care: psychometric properties. Health Qual Life Outcomes 2004; 2:42. [PMID: 15291958 PMCID: PMC514531 DOI: 10.1186/1477-7525-2-42] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2004] [Accepted: 08/03/2004] [Indexed: 11/10/2022] Open
Abstract
Background Currently there is a lot of interest in the flexible framework offered by item banks for measuring patient relevant outcomes, including functional status. However, there are few item banks, which have been developed to quantify functional status, as expressed by the ability to perform activities of daily life. Method This paper examines the psychometric properties of the AMC Linear Disability Score (ALDS) project item bank using an item response theory model and full information factor analysis. Data were collected from 555 respondents on a total of 160 items. Results Following the analysis, 79 items remained in the item bank. The remaining 81 items were excluded because of: difficulties in presentation (1 item); low levels of variation in response pattern (28 items); significant differences in measurement characteristics for males and females or for respondents under or over 85 years old (26 items); or lack of model fit to the data at item level (26 items). Conclusions It is conceivable that the item bank will have different measurement characteristics for other patient or demographic populations. However, these results indicate that the ALDS item bank has sound psychometric properties for respondents in residential care settings and could form a stable base for measuring functional status in a range of situations, including the implementation of computerised adaptive testing of functional status.
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Affiliation(s)
- Rebecca Holman
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands
| | - Robert Lindeboom
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands
| | - Marinus Vermeulen
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | - Rob J de Haan
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands
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Holman R, Glas CAW, Lindeboom R, Zwinderman AH, de Haan RJ. Practical methods for dealing with 'not applicable' item responses in the AMC Linear Disability Score project. Health Qual Life Outcomes 2004; 2:29. [PMID: 15200681 PMCID: PMC441407 DOI: 10.1186/1477-7525-2-29] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2004] [Accepted: 06/16/2004] [Indexed: 11/21/2022] Open
Abstract
Background Whenever questionnaires are used to collect data on constructs, such as functional status or health related quality of life, it is unlikely that all respondents will respond to all items. This paper examines ways of dealing with responses in a 'not applicable' category to items included in the AMC Linear Disability Score (ALDS) project item bank. Methods The data examined in this paper come from the responses of 392 respondents to 32 items and form part of the calibration sample for the ALDS item bank. The data are analysed using the one-parameter logistic item response theory model. The four practical strategies for dealing with this type of response are: cold deck imputation; hot deck imputation; treating the missing responses as if these items had never been offered to those individual patients; and using a model which takes account of the 'tendency to respond to items'. Results The item and respondent population parameter estimates were very similar for the strategies involving hot deck imputation; treating the missing responses as if these items had never been offered to those individual patients; and using a model which takes account of the 'tendency to respond to items'. The estimates obtained using the cold deck imputation method were substantially different. Conclusions The cold deck imputation method was not considered suitable for use in the ALDS item bank. The other three methods described can be usefully implemented in the ALDS item bank, depending on the purpose of the data analysis to be carried out. These three methods may be useful for other data sets examining similar constructs, when item response theory based methods are used.
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Affiliation(s)
- Rebecca Holman
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands
| | - Cees AW Glas
- Department of Educational Measurement and Data Analysis, University of Twente, Enschede, The Netherlands
| | - Robert Lindeboom
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands
| | - Aeilko H Zwinderman
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands
| | - Rob J de Haan
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands
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Holman R, Glas CAW, de Haan RJ. Power analysis in randomized clinical trials based on item response theory. CONTROLLED CLINICAL TRIALS 2003; 24:390-410. [PMID: 12865034 DOI: 10.1016/s0197-2456(03)00061-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Patient relevant outcomes, measured using questionnaires, are becoming increasingly popular endpoints in randomized clinical trials (RCTs). Recently, interest in the use of item response theory (IRT) to analyze the responses to such questionnaires has increased. In this paper, we used a simulation study to examine the small sample behavior of a test statistic designed to examine the difference in average latent trait level between two groups when the two-parameter logistic IRT model for binary data is used. The simulation study was extended to examine the relationship between the number of patients required in each arm of an RCT, the number of items used to assess them, and the power to detect minimal, moderate, and substantial treatment effects. The results show that the number of patients required in each arm of an RCT varies with the number of items used to assess the patients. However, as long as at least 20 items are used, the number of items barely affects the number of patients required in each arm of an RCT to detect effect sizes of 0.5 and 0.8 with a power of 80%. In addition, the number of items used has more effect on the number of patients required to detect an effect size of 0.2 with a power of 80%. For instance, if only five randomly selected items are used, it is necessary to include 950 patients in each arm, but if 50 items are used, only 450 are required in each arm. These results indicate that if an RCT is to be designed to detect small effects, it is inadvisable to use very short instruments analyzed using IRT. Finally, the SF-36, SF-12, and SF-8 instruments were considered in the same framework. Since these instruments consist of items scored in more than two categories, slightly different results were obtained.
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Affiliation(s)
- Rebecca Holman
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands.
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